AI Article Synopsis
- Duodenal atresia (DA) often coincides with cardiac defects that are significant for perioperative care, and while echocardiography is typically standard, this approach is being re-evaluated.
- A 16-year review analyzed preoperative evaluations, comparing nonselective echocardiography to selective strategies based on abnormal findings in cardiac, respiratory, or x-ray exams.
- The study found that using a selective echocardiography approach could reduce procedural frequency by 17-24% without compromising safety, though some major defects were still missed in all strategies.
Article Abstract
Background: Duodenal atresia (DA) is associated with cardiac defects that may have perioperative care implications. Standard preoperative care includes echocardiography to identify such cardiac defects, but this dogma has been challenged. We aimed to assess selective and selective strategies for preoperative echocardiography in DA patients.
Methods: Single-center retrospective review of neonates with DA over a 16-year period was performed. Data included preoperative cardiovascular and respiratory examination, chest x-ray, and echocardiography. We compared the current nonselective versus selective strategies, limiting preoperative echocardiogram to those in whom: (1) cardiac or respiratory or chest x-ray examination was abnormal, or (2) cardiac or respiratory examination was abnormal. Sensitivity, specificity, positive and negative predictive values were compared with chi-square tests.
Results: Seventy-one of 109 (65%) consecutive neonates with DA underwent preoperative echocardiography according to a nonselective, physician-determined strategy. Forty of 71 (56%) patients had cardiac defects, including 16/40 (27%) major defects. Sixteen additional postoperative echocardiograms revealed 2 missed major defects. In the same cohort, selective strategies would have performed 17-24% fewer echocardiograms without significant detriment in performance.
Conclusions: All strategies considered missed some major cardiac defects. A selective strategy, determining DA patients not requiring preoperative echocardiogram, could reduce the number of echocardiograms performed without compromising patient safety.
Type Of Study: Retrospective study.
Level Of Evidence: Level II.
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Source |
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| http://dx.doi.org/10.1016/j.jpedsurg.2017.08.046 | DOI Listing |
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